HomeMy WebLinkAboutBLD2025-00166 SFR - BLD Application - 2/27/2025 r6
Permit N� C1 �L 5 - )o JLo W
MASON COUNTY
COMMUNITY DEVELOPMENT
Permit Assistance Center,Building,Planning
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
Vol
O dLe
NAME: NAME:
MAILING DRESS: 9430 Jra &SAMV A6ig MAILING ADDRESS:
VCITY: Jim STATE-Aa ZIP: CITY: STATE: ZIP:
PHONE#1: 3W 023 55W PHONE: CELL:
01 PHONE#2: EMAIL:
EMAIL: Z01S60iE= L&I REG# EXP.
PRIMARY CONTACT: OWN ❑ CONTRACTOR❑ OTHER❑
NAME G E �5 � EMAIL
MAILING ADDRESS CITY STATE ZIP
33 PHONE CELL
PARCEL INFORMATION: ALA 2621-1 — 000 I I /Vm'
ARCEL NUMBER(12 Digit Num — ZONING
LEGAL DESCRIPTI N(Abbreviated)-
-9FIRE DIS RICT
SITE ADDRESS rj �7)—t� CITY
Y
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES[] NO SNOW LOAD:2+. sf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (Check all that apply):
SALTWATER❑ LAKE❑ RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NE ADDITION❑ ALTERATION[] REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial Bldg,Etc.) 5��
IS USE: PRIMARY SEASONAL❑ NUMBER OF BEDROOMS_-.,3 NUMBER OF BATHROOMS 2•5
HEATED STRUCTURE? YES(note Bid YES PU sj ojBid)[I NO❑
DESCRIBE WORK �•
S UARE F OTAGE:(proposed) At
1ST FLOOR] 83 sq.ft. 2ND WL00,1 sq.ft. 3RD FLOOR sq.ft. BASEMENT sq.ft.
DECK sq.ft. COVERED WD£2K JVo sq.ft. STORAGE
sq.ft. OTHER sq.ft.
` GARAGE sq.ft. Atta CARPORT sq.ft. Attached❑ Detached❑
MANUFACT6ED HOME INFORMATION: *4 7 S O F THE FLOOR PL�REUIRED*
MODEL YEAR
YIDTH BEDROOMS BATHS SERIAL NUMBER
V
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEWX EXISTING❑
PLUMBING IN STRUCTURE? YES NO❑ /jyes,attach completed Water Adequacy Form
PERIMETER/FOUNDATION DRAINS PROPOSED? YE�6 NO❑ EXISTING SQ.FT.
EXISTING BEDROOMS6 PROPOSED BEDROOMS 3— TOTAL BEDROOMS_,3
OWNER acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is by
signature below.I declare that I am the owner and I further declare that I am entitled to receive this permit and to do the work as proposed.I have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,represents that the information provided is accurate and grants employees of Mason County access to the above described property
and structure(s)for review and inspection. This permit/application becomes null&void If work or authorized construction is not commenced within 180
days or if construction work is suspended for a period of 180 days.
PROOF O TINUATI��N THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
APPLI I OF 180 DAYS OF-MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
OQQ�1T-9�6(ZE 14.08.42)
(Tgn'ature
1
of OWNER Must be sl nod b th OWNER Date
ADEPAENTAILRE APPROVED ATE DENIED DATE TAGS/NOTES/CO}VDITIONS
BUILDING DEPARTMENT Z-Z
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
2- 4jatA l,Uf 1.20 -paao
-�U Permit No: �tCt ��J (�d 1(..D(p
MASON COUNTY
COMMUNITY DEVELOPMENT
Permit Assistance Center, Building,Planning
PLUMBING & MECHANICAL PERMIT APPLICATION
OWNER FORMATION CONTRACTOR INFORMATION:
NAM NAME:
MAIL G ADDRESS. E Jj- MAILING ADDRESS:
CITY. b STATE:W>11 ZIP:ftq-16 CITY: STATE: ZIP:
Is'PHONE:3 LQ 6 PHONE: CELL:
2°d PHON : EMAIL :
EMAIL. 4% L&I REG# EXP.
CO
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number): 31908 " -OML40 Zoning:
LEGAL DESCRIPTI N(Abbreviated):
SITE ADDRESS: f CITY: r 14
DIRECTIONS TO SITE ADDRESS:
�02-4- Obi 11
TYPE OF JOB:
NEW=ADD=ALT=REPAIR=OTHER=USE OF BUILDING
LOCATION OF FIXTURES/UNITS-1 IT FLOOR=2ND FLOOR=BASEMENT=GARAGE[]OTHER
PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS
Type of Fixture No.of gixtures Fees Fuel Type:Electric=LPG[�Vatural Gas[�Ductless=
Toilets Type of Unit No.of Units Fees
Bathroom Sink �— Furnace 1
Bath Tubs � Heat Pump �—
Showers Spot Vent Fan
Water Heater Propane Tank T
Clothes Washer 9&"tlets
Kitchen Sinks oo as/Pellet Stove
Dishwasher �— Kitchen Exhaust Hood
Hose bibs Dryer Vent
Other Solar Panel ^
Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
OWNER acknowledge submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of such is
by signature below. I declare that I am the owner,owners legal representative,or contractor. I further declare that I am entitled to receive this
permit and to do the work as proposed.I have obtained permission from all the necessary parties,including any easement holder or parties of
interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of
Masonqpun ss to the above de cribed property and structure(s)for review and inspection.This permit/application becomes null&void
if wor o on d construction' of commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF
OF C I ,ON
OFTHI RMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS
WILL ATE TH PLICATION.
X.
6�t,indture of Owner bate
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT EC 7--Z?-ZS DEPARTMENT
FIRE MARSHAL
Rev:1/27/2016 JBN
11 1 S 4 W C_ �' GI YlGjJ�J
Name n Parcel#i9 BLD# I t'0 (�
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 2 of 2)
Based Upon the information you have provided a Stormwater Site Plan IS Required for this development activity.
Title 14,Chapter 14.48 of the Mason Cougty Code(MCC)regulates compliance requirements for Stormwater
Management in this jurisdiction.A complete copy of the ordinance can be found on the Mason County website:
hitp//www.co.mason.wa—us/code/commissioners/index.htm
Please follow the links to "Title 14,Chapter 14.48 Stormwater Management".
Regulated activities shall be conducted only after Mason County Public Works approves a stormwater site plan
(Mason County Code Title 14 Chapter 14.48 section 14.48.70).You will receive a copy of the Public Works document
entitled"Managing Storm Drainage on Small Lots,The Small Parcel Stormwater Site Plan". This document will assist
you in preparing the necessary information and plans for Public Works to review and approve. Per Department of
Public Works this document will constitute an approved plan if all of the relevant details* are to be installed in
their entirety AND no part of the stormwater system adversely affects any septic system(see Environmental Health
information below). If an alternative system is to be used a plan will need to be submitted to Public Works for approval.
A design by a registered professional may be required for more complex sites.
*These details are found in the document Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan
on the pages that begin with"Handout"
PLEASE INITIAL BELOW TO INDICATE THE STORMWATER MANAGEMENT PLAN FOR THIS SITE
A) l-The relevant details from Managing Storm Drainage on Small Lots, The Small Parcel Stormwater Site Plan will be installed
in their entirety AND the system will be located as not to adversely affect any septic systems on this,or any other,parcel.
B) An alternative plan and/or professional design will be submitted to the Department of Public Works for approval AND the
system will be located as not to adversely affect any septic systems on this,or any other,parcel.
If you have further questions pertaining to parcel drainage and stormwater management Mason County's Public Works
Department can provide additional instructions,guidance and examples.(Section 14.48.130)contact Public works at:
Phone: (360)-427-9670 EXT.450
Mail: P 0 Box 1850, Shelton WA 98584
Physical:415 N 6th St, Shelton WA 98584
If this development has, or will have,a septic/drainfield system you may need to contact Mason County Division of
Environmental Health to ensure that the stormwater system will not adversely affect the septic system of this,or
any other,parcel.You may also wish to consult with the septic design professional involved with the project.Mason
County Division of Environmental Health can be reached at:
Phone:(360)-427-9670 EXT. 352
Mail:P 0 Box 1666,Shelton WA 98584
Physical:426 W Cedar St,Shelton WA 98584
A condition will be added to the building permit that states,in part,that all conditions the stormwater site plan will be mct
prior to a request for final inspection of the building permit.
OwnerBuil r/Ag t Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Ackn wled en o such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
firth ac o led e e information provided is accurate and employees of Mason County are granted access to the above-
descn ed p op rty view and inspecti a required.
X Owner/Agent/Contractor(circle one)Date:
Page 2 o 2
Name Parcel# BLD#
Mason County
Department of Community Development
Small Parcel Stormwater Management Application/Worksheet (page 1 of 2)
Per Mason County Code, Title 14, Chapter 14.48 a stormwater site plan is required whenever a building application is
made for residential development, or redevelopment',with more than 2,000 square feet of impervious surface'.
'Redevelopment means,on an already developed site,the creation or addition of impervious surfaces,structural development
including construction,installation or expansion of a building or other structure,and/or replacement of impervious surface that is not
part of a routine maintenance activity,and land disturbing activities associated with structural or impervious redevelopment.
'Common impervious surfaces include,but are not limited to,rooftops,walkways,patios,driveways,parking lots or storage areas,
concrete or asphalt paving,gravel roads,packed earthen materials,and oiled,macadam or other surfaces which similarly impede the
natural infiltration of stormwater.Open,uncovered retention/detention facilities shall not be considered as impervious surfaces.
To Calculate Impervious Surfaces Please Complete This Table
Surface Type Length X Width = Area *All dimensions in feet
Buildings X =
X = Measurements for buildings are taken at the
X _ perimeter of the farthest projections(example:
eaves/gutters)
X =
Driveways X =
X = Length of drive begins at the right of way
X =
Parking Areas X =
X = Any paved, gravel or packed area per definition
above table
X =
Patios/Walks X =
X = Any paved, gravel or packed area per definition
above table
X =
Others X =
X = If the total impervious area of the proposed site
X = development is greater than 2000 square feet a
Small Parcel Stormwater Site Plan is Required
Total Impervious Surface Area (sum of all areas)
If the Total Impervious Surface Area is LESS THAN 2000 Square Feet,please read, acknowledge and sign below.
Based Upon the information you have provided a Stormwater Site Plan IS NOT required for this development activity.
Owner/Builder/Agent Acknowledges that submission of inaccurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below.I declare that I am the owner,owner's legal representative,or the contractor.I
further acknowledge that the information provided is accurate and employees of Mason County are granted access to the above-
described property for review and inspection as may be required.
X Owner/Agent/Contractor(circle one)Date:
If the Total Impervious Surface Area is GREATER THAN 2000 Square Feet,please read,acknowledge and sign
the information provided on page 2 of 2.
Page 1 of 2
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2221831 MASON
02/19/2025 03 45 PM NOTCE CO IAA
KNOTTS, AMBER #206602 Rec Fee_ $304.50 Pages: 2
IIII III IIIIII III IIII IIIIIII llllll IIII IIII IIIII IIIII IIIIIII III IIIII IIII IIII
Return To t1
5171CL ftNt-WA 9
Grantor(s): (1) IY�/
Grantee(s): (1) PUBLIC
Legal Description (1) -BLA 2.02�4 —
(Abbreviated form;i.e. lot, block, plat orsectio , township, range)
Assessor's Tax Parcel: (1) 1D—A- �5L-ia0 UA—o—
?6T �Gvj
TITLE NOTIFICATION OF WATER RESOURCE INVENTORY AREA (WRIA)
I (\Ale), the undersigned grantor(s), hereby place this notice on record that the described real
estate situated in Mason County, State of Washington is subject to water use restrictions and
conditions set by Washington State Senate Bill 6091 and Mason County Code 6.68. These
restrictions and conditions are based on location of property and/or Water Resource
Inventory Area or WRIA.
WRIA: ( �—
Maximum Annual Average Gallons Per Day: �� gallons
Dated on t " tntor(s
ay of 20
Signa r
(1) (2)
State of Washington )
County of Mason )
Page 1 of 2
I,the undersigned, a o Public i and for the above n_ame_d County and State, do hereby
cerj4V th4 on this F� f , 20 ,
personal) appeared before me,who is known to be
signer of the above itistrument, and acknowledged that he (sh (they) signe
GIVEN under my hand and official seal the day an ar last ove ten
gs
f u c in tat of Washington,
�1bTAl�yA���; _ iding at
N•
23038426 - My commission expires:
pU8LIC
Page 2 of 2
8 0) 101
�E•
SCALE-1"=100'-0" 36' / 0' NOTES:
RESTRICTIVE LAYER BELOW 74"
-SEVEN TIMES RULE MET
10, / NO WELLS WITHIN 100'OF DRAINFIELD
R/A / 9/13/24 ELAPSE TIME METER AND EVENT COUNTER REQUIRED RISERS TO SURFACE REQUIRED OVER ALL TANK LIDS
6' ''>:%
FMrGROUNDROPERTY CORNER(RBM=100.0) SOIL LOGS
1) GRAVELLY SANDY LOAM 0-28"
EXTREMELY GRAVELLY COARSE SAND 28-78"
�€fU1=TAIL / Q ,,;` ,�. :m,
AOAFA NVMTER 2) GRAVELLY SANDY LOAM 0-28"
�'�/ 6 1`GEi6Sl'S1Skri:NE "' GRAVELLY COARSE SAND 28-74"
3) GRAVELLY SANDY LOAM 0-32"
r / EXTREMELY GRAVELLY COARSE SAND 32-72"
' y 5 4) GRAVELLY SANDY LOAM 0-26"
GRAVELLY COARSE SAND 26-48"
5) GRAVELLY SANDY LOAM 0-32"
L CEMENTED TILL 32"+
4
_ TANK DETAIL-NO SCALE
106
Tomp
O � r" uww[hx� /¢mYE vre[
ovti r—"orr
RW WAI.BER In""ICAL� iat nw
O
SCALE-1"=30'-0" THIS IS NOT A SURVEY:
SITE FEATURES,TOPOGRAPHY,ELEVATIONS AND BENCHMARKS ARE BASED ON ASSUMED DATUM
1O PROPOSED 3 BEDROOM RESIDENCE PROVIDED BY THE OW ENER AND COUNTY PLANNING RECORDS AND ARE INTENDED ONLY FOR THE
REVIEW AND CONSTRUCTION OF THE PROPOSED SEPTIC SYSTEM DESIGN. JIM HUNTER&ASSOCIATES
O PROPOSED DRIVE RECOMMENDS THAT A LICENSED PROFESSIONAL LAND SURVEYOR ALWAYS BE USED TO SET CORNER,
ESTABLISH LOT LINES,DETERMINE ELEVATIONS AND TOPOGRAPHY AND/OR PROVIDE A LEGAL SITE PLAN.
O3 PROPOSED STUBOUT/CLEANOUT(IE.-104.0)
O PROPOSED 4"GRAVITY TIGHTLINE TO TANKS(CLEANOUTS REQUIRED EVERY 100FT) A FEE MAY BE CHARGED AFTER INSTALLATION FOR FINAL INSPECTION&RECORD DRAWING
O PROPOSED SEPTIC TANK(IN.EL.-102.0/OUT.EL.-101.7) EH APPROVED HWY 101 TO LYNCH RD TO LEFT ON BREWER JIM HUNTER AND ASSOCIATES
FOLLOW BREWER PAST DRIVE-IN TO SITE ON RIGHT. P.O.BOX 162 OLY WA 98507 753-1226 )HANDAssonATES4HOTMAILCOM
O PROPOSED PUMP CHAMBER(PUMP EL.-97.0) D.Anderson 09/25/2024 DESIGNER-ADAM HUNTER
OEXISTING WELL SEPTIC SYSTEM DESIGN FOR-
08 25'-2"PVC TIGHTLINE(SCH40) AMBER KNOTTS
SITE ADDR-
O PROPOSED D.F.AND R/A o XX BREWER LN
LYNCH LEGAL- PROPOSED BLA JOF 2
= TP# 319083200040 SITE#